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Getting to Know Your Benefits

Getting to Know Your Benefits

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Getting to Know Your Benefits

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  1. Getting to Know Your Benefits New Employee Health and Related Benefits Primer Department of Human Resource Management Office of Health Benefits

  2. Getting Started What is the State Health Benefits Program? What benefits are offered? Who is eligible? How do I enroll? How can I find more information?

  3. State Health Benefits Program Administers your health coverage and other benefits State health insurance Flexible Reimbursement Accounts (FRAs) CommonHealth wellness program Optional long-term care insurance

  4. State Health Benefits Program Determines Who is eligible for benefits Policies and how they are interpreted Collects premiums and pays claims Communicates benefits information Provides customer service to agencies and employees Manages vendor contracts

  5. Benefits Offered Health coverage COVA Care self-insured health plan COVA HDHP self-insured health plan Kaiser Permanente HMO (Northern Virginia only) Flexible Benefits Pre-tax reduction of employee portion of the monthly premium Medical Expense FRA Dependent Care FRA

  6. Benefits Offered CommonHealth wellness program Fitness programs and challenges Included with health coverage at no additional cost Optional long-term care insurance through DHRM Individual plan Total premium paid by employee May continue coverage after you leave state employment

  7. Benefits Offered By Other Agencies Automatic long-term care insurance through Virginia Sickness and Disability Program (visit the VRS Web site for more information) Voluntary provider program through the Department of Accounts

  8. Health Coverage For Full-time employees State pays the major portion of monthly health insurance premiums Employee contributes less than one-fifth of the cost of his or her health insurance For COVA Care plan Premiums placed in Health Insurance Fund, from which claims are paid State plan carriers administer the benefits, but state pays the claims

  9. Health Coverage COVA Care state health plan Provider networks throughout Virginia and nationally Do not need to designate a PCP No referrals to specialists Basic plan has no out-of-network coverage except in emergencies May purchase additional coverage options (Expanded Dental, Vision, Hearing, Out-of-Network)

  10. Health Coverage COVA Care health plan administrators Medical (Anthem BC&BS) Dental (Delta Dental) Prescription Drugs (Medco) Behavioral Health and Employee Assistance Program (ValueOptions)

  11. Health Coverage COVA HDHP (high deductible health plan) Administered by Anthem Enrollment allows participation in a Health Savings Account (HSA) Provider networks throughout Virginia and nationally High deductible and out-of-pocket limits indexed for inflation each year Do not need to designate a PCP No referrals to specialists Plan has no out-of-network coverage except in emergencies

  12. Health Coverage Kaiser Permanente HMO (Northern Virginia only) More limited provider network Kaiser hospitals and physicians Coverage different than COVA Care No additional coverage options

  13. Eligible for Health Coverage Full-time, salaried, classified employees or faculty Work at least 32 hours per week Part-time classified employees Work at least 20 hours but less than 32 hours per week Pay total health insurance premium

  14. Eligible for Health Coverage Legally married spouse of employee Dependents as defined by the program (go to the DHRM Web site, see your Member Handbook or ask your Benefits Administrator)

  15. Eligible for Flexible Benefits Employee eligible for the State Health Benefits Program May enroll in a Dependent Care FRA and Medical Expense FRA when hired

  16. Eligible for CommonHealth Employees eligible for the State Health Benefits Program Full-time, salaried, classified employees or faculty Part-time classified employees Do not have to be enrolled in the State Health Benefits Program

  17. Eligible for DHRM Long-Term Care Full-time salaried, classified employees or faculty and part-time classified, including their: Spouses Parents and parents-in-law Retirees and their spouses or surviving spouses

  18. How to Enroll You have 31 DAYS to enroll in health benefits

  19. How to Enroll Within DAYS!

  20. How to Enroll • Visit EmployeeDirect at http://edirect.virginia.gov or • Submit a completed enrollment form to your Benefits Administrator

  21. Keep in Mind WITHIN DAYS When your health coverage goes into effect depends on: Your date of employment, and When you submit your request Some exceptions apply, see your Benefits Administrator

  22. Keep in Mind COVERAGE CHART EXAMPLES

  23. How to Enroll • “31 Day” Rule applies to all benefits except DHRM optional long-term care insurance • There is a 60-day window to apply for optional long-term care insurance for guaranteed issue of the policy

  24. How to Enroll • “31 Day” rule also applies to events during the year that allow you to make a change • Qualifying mid-year events: • Life events such as marriage, divorce, birth of a child • Other events related to your employment and/or family • See the list on the DHRM Web site or in your Member Handbook

  25. More Information • Resources include: • DHRM Web site: www.dhrm.virginia.gov • Compensation and Benefits • Links to COVA Care and Kaiser Permanente • Announcements • Publications and Reports • Health Benefits Headlines Web portal • Open Enrollment link (spring only)

  26. More Information • Resources include: • Member Handbook • Spotlight newsletter (fall and spring issues) • All About Your Benefits new employee brochure